Reducing Hazardous Alcohol Use & HIV Viral Load:An RCT in ART Clinics in Vietnam

描述（由申请人提供）：项目摘要/摘要HIV感染者危险饮酒与严重的健康后果相关，包括抗逆转录病毒治疗（ART）依从性降低和病毒抑制降低。在艾滋病毒医疗保健环境中，危险饮酒对艾滋病毒感染者造成的严重后果往往被忽视。在许多低资源环境中，饮酒被广泛接受，对潜在风险的了解有限。在越南，社会鼓励饮酒，危险饮酒普遍存在;超过20%的ART患者是危险饮酒者。注射吸毒者（IDU）占越南艾滋病毒感染者的很大比例，许多人同时感染HBV和HCV。危险饮酒与合并感染HBV和HCV的HIV感染者的肝病进展增加显著相关，进一步强调了在这种情况下迫切需要有效的酒精减少干预措施。 我们提出了一项三臂随机对照试验，以评估两种循证干预措施的比较有效性和成本效益，以减少越南危险和大量饮酒的HIV感染ART门诊患者中的酒精使用。动机增强疗法（MET）是一种4次干预，旨在通过内部动机的改变来产生变化，而认知行为疗法（CBT）是一种更密集的12次干预，重点是培养管理酒精触发因素的技能。使用创新的优效性-等效性设计，我们将评估这两种干预措施是否比仅评估对照措施产生更好的结局，同时比较干预措施对患者重要结局和成本的影响。我们的主要成果将包括戒酒、艾滋病毒抑制和增量成本效益，所有这些都将在每次干预开始后一年内进行测量。

DESCRIPTION (provided by applicant): Project Summary/Abstract Hazardous drinking among HIV-infected individuals is associated with serious health outcomes, including decreased adherence to antiretroviral therapy (ART) and decreased virologic suppression. The serious consequences of hazardous alcohol use for HIV infected individuals are often neglected in HIV health care settings. In many low resource settings, alcohol use is widely accepted and knowledge of potential risks is limited. In Vietnam, alcohol use is socially encouraged and hazardous drinking pervasive; over 20% of ART patients are hazardous drinkers. Injection drug users (IDU) comprise a large proportion of those infected with HIV in Vietnam and many are co-infected with HBV and HCV. Hazardous drinking is significantly associated with increased progression of liver disease among HIV-infected individuals co-infected with HBV and HCV, further underscoring the urgent need for effective alcohol reduction interventions in this context. We propose a three-arm randomized controlled trial to evaluate the comparative effectiveness and cost-effectiveness of two evidence-based interventions to reduce alcohol use among hazardous and heavy drinking HIV-infected ART clinic patients in Vietnam. Motivational Enhancement Therapy (MET) is a 4-session intervention that seeks to produce change through internally motivated change, while Cognitive Behavioral Therapy (CBT) is a more intensive, 12-session intervention that focuses on developing skills to manage triggers for alcohol. Using an innovative superiority-equivalency design, we will assess whether these two interventions result in better outcomes than an assessment-only control while simultaneously comparing the interventions against each other in terms of impact on patient-important outcomes and costs. Our primary outcomes will include abstinence from alcohol, HIV viral suppression, and incremental cost-effectiveness, all measured up to one year after starting each intervention.